Provider Demographics
NPI:1396005237
Name:BROWN, MICHAEL JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
Last Name:BROWN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 WOODARD AVE
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-2051
Mailing Address - Country:US
Mailing Address - Phone:414-587-2485
Mailing Address - Fax:
Practice Address - Street 1:106 S HOLMEN DR
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9467
Practice Address - Country:US
Practice Address - Phone:608-526-9243
Practice Address - Fax:608-526-1099
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6981-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice